title: Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians.
abstract: OBJECTIVE
  The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease.
  
  
  METHODS
  A sample of 20 consecutive CT-KUB scans for suspected acute calculous disease was compiled from the medical imaging department of an adult tertiary teaching hospital. Ten EPs with a minimum of 2 years' experience post-Fellowship interpreted each scan using a template form. The total sample of 200 reports by EPs was compared with the formal radiology report for agreement in detecting renal tract stones, signs of obstruction and other clinical findings. Interrater agreement and the kappa statistic were used for comparative data analysis.
  
  
  RESULTS
  There was a high level of agreement (%, kappa value) between EPs and radiologists for the detection of large (≥5 mm) calculi (94.5%, κ 0.89), signs of obstruction (93%, κ 0.86) and clinically significant findings (90%, κ 0.78). The level of agreement was low for the detection of small (<5 mm) calculi (79%, κ 0.48) and clinically non-significant findings (67.5%, κ 0.33).
  
  
  CONCLUSIONS
  EPs can accurately detect clinically significant acute calculous disease and signs of obstruction on CT-KUB, allowing for ongoing acute management and early disposition of the patient. However, their findings should be verified against the formal radiology report when available.
authors.affiliation: Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia.
authors.forename: Momtaz
authors.initials: M
authors.lastname: Rafi
authors.forename: Amith
authors.initials: A
authors.lastname: Shetty
authors.forename: Naren
authors.initials: N
authors.lastname: Gunja
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004635:Emergency Medicine / Q000592:standards*; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*; D001744:Urinary Bladder Calculi / Q000000981:diagnostic imaging*
keywords: emergency physician; helical computed tomography; renal colic; urinary tract stone